Comparison Of The Consistency Between Hans And Muris Algorithms In Different Subtypes Of Diffuse Large B-cell Lymphoma

Background:Diffuse Large B-cell Lymphoma(DLBCL)is the most common Non-Hodgkin's lymphoma subtype with high heterogenicity,diverse manifestations and pathological complex.Pathological subtypes are mainly classified by gene expression profiles and immunohistochemistry,which associate with treatment and prognosis.Though gene expression profiles are accurate,its complex technology and high cost limit its clinical application.Immunohistochemistry is widely used in clinical work,especially Hans and Muris algorithms,and different immunohistochemistry algorithms lead to the inconsistency of pathological diagnosis subtypes.Therefore,it is necessary to compare the consistency of different immunohistochemical classifications and the relationship with prognosis of patients,so as to guide the selection of DLBCL treatment.Objective:DLBCL patients in our hospital for the last 6 years was retrospective conducted to analyze the consistency and difference of the clinical baseline features,pathological subtypes and prognostic risk factors of two immunohistochemical classifications of Hans and Muris algorithms.Materials and methods:Patients who was newly diagnosed DLBCL without being treated in our hospital between October 2011 and March 2017 were collected and divided into two groups according to Hans and Muris immunohistochemistry algorithm.The general conditions,history characteristics,blood routine,serum biochemical parameters,lactate dehydrogenase,CT,and pathological immunohistochemistry were collected from these patients,while the treatment status of all patients was collected and followed up.Then SPSS 22.0 and Graphpad prism7 software was used for statistical analysis.Results:1.The patient's clinical baseline characteristics were well-consistent between the two algorithm's subtypes.Except the differences in WBC counts between the GCB and N-GCB subtypes in the Hans algorithm(P=0.047)and the age distribution in the subtypes of the Muris algorithm(P=0.009),other clinical feature such as sex,distribution area,LDH,Ann Arbor staging,B symptom,ECOG score,IPI score and NCCN IPI score did not have significant difference(P>0.05),showing consistent and comparable.2.Differences consist in the diagnosis of pathological subtypes between Hans and Muris algorithms.There were 52 cases GCB patients and 72 cases of N-GCB patients in the Hans algorithms group,which were consistent with Muris algorithms83% and 67% respectively,whereas 67 cases and 57 cases were classified into Muris algorithms group with coincidence with Hans 64% and 84% respecitvely.These two algorithms show significant differences in the quantity of GCB and N-GCB subtypes(P=0.057)?3.The two algorithms make no difference to predict OS,and Muris algorithms predict PFS better than Hans.In the Hans algorithm,OS between GCB and N-GCB patients show statistically significant difference(P<0.05)whileas there was no difference in PFS between patients(P>0.05);OS and PFS were significantly different between GCB and N-GCB in Muris algorithm,P<0.05.4.In the single factor analysis,the distribution of the lesions(intra and extranode),liver function,LDH,IPI score,and Hans and Muris algorithm were the prognosis of the patients independently(P<0.05)while multivariate analysis showed the distribution area,NCCN-IPI score and treatment(CHOP/R-CHOP)affected the prognosis of patients(P<0.05).The Hans algorithm did not appear the superiority of the R-CHOP regimen(P>0.05).The N-GCB group of the Muris algorithm showed that the R-CHOP regimen improved the prognosis of the patients,OS(P=0.0432).Conclusion:1.The two classifications had inconsistent in the diagnosis of DLBCL pathological subtypes,and the coincidence rate of GCB and N-GCB was 73.5-75.5%.Compared with Muris classification,the PFS of patients in GCB and N-GCB groups with Hans algorithm did not appear different,nor shows the superiority of R-CHOP treatment.2.Single factor analysis showed that except the distribution area(intra node,extra nodal),liver function,LDH,and IPI scores,Hans and Muris algorithm independently affected the prognosis of the patients.